Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial.

Background: Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes.

Objective: To examine practice contextual features that moderate intervention effectiveness.

Practice facilitation to improve diabetes care in primary care: a report from the EPIC randomized clinical trial.

Purpose: We investigated 3 approaches for implementing the Chronic Care Model to improve diabetes care: (1) practice facilitation over 6 months using a reflective adaptive process (RAP) approach; (2) practice facilitation for up to 18 months using a continuous quality improvement (CQI) approach; and (3) providing self-directed (SD) practices with model information and resources, without facilitation.

Methods: We conducted a cluster-randomized trial, called Enhancing Practice, Improving Care (EPIC), that compared these approaches among 40 small to midsized primary care practices. At baseline and 9 months and 18 months after enrollment, we assessed practice diabetes quality measures from chart audits and Practice Culture Assessment scores from clinician and staff surveys.

Colorado's Patient-Centered Medical Home Pilot met numerous obstacles, yet saw results such as reduced hospital admissions.

The Colorado Multipayer Patient-Centered Medical Home Pilot, which ran from May 2009 through April 2012, was one of the first voluntary multipayer medical home pilot projects in the country. Six health plans, the state's high-risk pool carrier, and sixteen family or internal medicine practices with approximately 100,000 patients participated. Although a full analysis is currently under way, preliminary results show that the pilot significantly reduced emergency department visits and also reduced hospital admissions, particularly for patients with multiple chronic conditions.

Using information technology to improve adult immunization delivery in an integrated urban health system.

Background: Adult immunizations prevent morbidity and mortality yet coverage remains suboptimal, in part due to missed opportunities. Clinical decision support systems (CDSSs) can improve immunization rates when integrated into routine work flow, implemented wherever care is delivered, and used by staff who can act on the recommendation.

Methods: An adult immunization improvement project was undertaken in a large integrated, safety-net health care system.

State consensus guideline for the prevention of cardiovascular disease in primary care settings.

Cardiovascular disease (CVD) is the leading cause of death in the United States and is often attributable to poorly controlled yet modifiable risk factors. All national guidelines strongly recommend performing global CVD risk assessments to inform therapeutic intensity, but only a minority of clinicians regularly quantitate their patient's CVD risk. Not surprisingly, many patients are not at goal with regard to blood pressure, lipids, and the appropriate receipt of antiplatelet therapy.